Patient-Reported Outcomes are Important Elements of Psoriasis Treatment Decision Making: A Discrete Choice Experiment Survey of Dermatologists in the United States

Publication date: Available online 29 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Steven R. Feldman, Stephane A. Regnier, Alexandra Chirilov, Felix Hey, Isabelle Gilloteau, David Cella

Abstract

Background

Psoriasis Area and Severity Index (PASI) response rates have been the benchmark for evaluating treatment efficacy in moderate-to-severe psoriasis trials.

Objective

Understand how dermatologists assess biologics and what trade-off rules they apply when planning psoriasis treatment.

Methods

Two online surveys of 130 and 129 U.S. dermatologists (Survey 1 and 2, respectively) were conducted using direct and indirect elicitation via discrete-choice experiment. Respondents were asked to choose hypothetical biologics based on six attributes (PASI 75 or 90 response rate, infection risk, dosing frequency, and three patient-reported outcomes [PROs] [relief of depression and itching, impact on usual activities]).

Results

Most dermatologists (Survey 1: 74%, Survey 2: 76%) reported using both PASI and PROs when selecting a biologic. PASI response rate was the most important attribute (35–38% of overall decision weight), while combined PRO attributes had similar importance (36% of decision weight). Infection risk and dosing frequency influenced the decision to a lesser extent.

Limitations

Potential bias in considering three PROs versus one PASI rate and one safety attribute.

Conclusion

PASI is most important for dermatologists selecting biologics, but PROs are also considered, especially when PASI response rate is similar between treatments. PRO data should be collected in moderate-to severe-psoriasis trials.

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